Vaginal Birth after Caesarean
Section
The aim of this leaflet is to provide you with information about your options for
delivering your baby if you have previously had one baby born by caesarean
section (CS).
I had a Caesarean Section in my last pregnancy. How will I deliver my baby this
time?
There are lots of reasons why you may have been advised to have a Caesarean Section
last time in order to deliver your baby safely. In the majority of cases, this does not mean
that you automatically need a Caesarean Section in this pregnancy. Your doctor will
discuss your options when you first come the antenatal clinic, either to try for a vaginal
birth (VBAC = vaginal birth after caesarean) or to have an elective (planned) Caesarean
Section.
What are the chances of being able to have a vaginal birth?
At Hillingdon Hospital, about two out of three mothers who try for a vaginal birth are
successful. Overall, your risk of complications is lower if you are able to have a vaginal
birth than if you have a Caesarean Section.
What are the benefits of a vaginal birth?
In general, your recovery time will be quicker if you have a vaginal birth than if you have
a Caesarean Section. This includes a shorter stay in hospital and often, a more
successful start to breastfeeding. You will also be able to resume normal activities at
home sooner, such as driving and caring for your other children.
What are the risks of a vaginal birth?
When you have had a Caesarean Section before, the most serious risk is that the scar
on the womb may tear open inside your stomach once your contractions start (scar
rupture). This is a rare event. It happens in about one out of 200 pregnancies. Internal
and external bleeding may occur which can be severe. It may be serious enough to
affect your baby. If we are suspicious that it is happening, we need to deliver your baby
urgently, which would mean by Caesarean Section again, unless you are ready for a
vaginal birth.
What happens if I choose to try for a vaginal birth?
When you start to have regular contractions or your waters break, you should ring the
Labour Ward and let them know what is happening. It is important that you tell the staff
that you have had a Caesarean Section in the past. Although the risk of scar rupture
is small, we will take some precautions when we look after you in labour. These
include putting a venflon (drip) in your hand so that we can give you fluids quickly if a
Caesarean Section becomes necessary. We send blood tests to the laboratory in
case you need a blood transfusion. We monitor you for signs that there may be a
problem with the scar. This means checking for any heavy vaginal bleeding and
assessing any unusual pain, different from your contractions. The most important
way in which we can help is to monitor your baby’s heartbeat continuously. This is
usually done using a belt around your stomach recording the baby’s heartbeat and
your contractions (CTG = cardiotocograph). If it is difficult to get a good reading, the
midwife or doctor may advise that we put a clip on your baby’s healp electrode) once
your waters have broken. If there is a problem with your baby’s heartbeat recording,
this may be a sign that there is something wrong internally with the scar on your
womb. This may mean having to deliver your baby by Caesarean Section as we
mentioned earlier.
What can I have for pain relief?
If you choose to try for a vaginal birth, you have the usual options for pain relief in
labour. You can have TENS, gas and air (entonox), pethidine or an epidural. What
are the benefits of having a planned CS? If you choose a planned Caesarean
Section, you avoid the uncertainty of needing an emergency Caesarean Section in
labour.
If I choose to have a planned Caesarean Section, when will it be arranged?
Some patients may be advised to have a planned Caesarean Section in this
pregnancy. Others choose this way of delivering their babies rather than trying for a
VBAC. We would plan a Caesarean Section at approx 39 weeks of pregnancy ie.
about a week before your due date. It has been shown that delivering the baby at or
after this time lowers the risk of him/her having minor breathing problems after birth.
What are the risks of a Caesarean Section?
Your doctor will discuss the risks of choosing a Caesarean Section with you. A
Caesarean Section generally means that your blood loss at the time of the delivery is
more than someone who has a vaginal birth. This means you have a slightly
increased risk of needing a blood transfusion. You will be given a dose of antibiotics
during your surgery to reduce the chance of getting an infection, for example in your
womb or in your bladder. This will not affect breastfeeding. After the operation, you
will be given a daily blood-thinning injection (heparin). This lowers the risk of a blood
clot forming in your legs which can spread to the chest (thrombosis). The injections
are given until you go home.
We also warn you about the small but potentially serious risk of damage to other
organs inside your stomach during the operation. After your previous Caesarean
Section, scar tissue will have formed inside as a normal part of the healing process.
Sometimes, this can involve organs such as the bladder, or less commonly, the bowel.
When we deliver your baby this time, we have to take routine steps to avoid injuring such
structures. We need to repair any damage immediately if it happens and it may mean
that you are advised to stay in hospital for longer.
In general, you are likely to take longer to recover from a Caesarean Section than from a
vaginal birth. This may be something you need to consider for looking after your other
children. You would usually stay in hospital for three to four days and it is advised that
you do not drive for about six weeks.
What happens in another pregnancy if I have a CS this time?
If you either choose a planned Caesarean Section this time or if you need an emergency
one, we recommend that any future babies are delivered by Caesarean Section. There is
no limit to the number of Caesarean Section you can have, but the operations become
technically more difficult each time. The risks increase, particularly related to problems
with the position of the placenta
What happens if my pregnancy goes past my due date?
If you choose to have a vaginal birth, it is most likely to be successful if your labour starts
naturally. Provided that your pregnancy progresses normally, you can wait up to 10-12
days past yourdue date for labour to start. If you get to this point and labour does not
appear to be starting, we would need to assess you and discuss your options with you.
There is evidence that giving drugs to start labour artificially (induction) increases the
small riskof problems with scar rupture. In some situations, a planned Caesarean
Section is offered at this stage.
When do I have to make a decision?
When your midwife sees you for booking, she will advise you to see one of the doctors in
the hospital to discuss your options in this pregnancy. The doctor may need to look at
your old notes or write to your previous hospital if you had your baby somewhere other
than Hillingdon. We will see you again at about 36 weeks. At this visit, we can answer
any further questions, and we can book a date for a planned Caesarean Section if that is
what you choose.
If you decide to book a Caesarean Section and your labour start before the planned
date, contact the Labour Ward. We will assess the situation when you come in and
discuss with you whether it is still advisable to have the operation. If your labour is
progressing normally, you may change your mind and go for a vaginal birth.
Who can I contact if I have any concerns?
This information is not intended to replace discussion with the staff who are looking after
you. If you have any questions regarding the contents of the leaflet, please feel free to
discuss them with your midwife or doctor. Alternatively, you can contact the Labour Ward
Manager, Saras Biln, on 01895 279979.
Further information
A Guide to Effective Care in Pregnancy and Childbirth Enkin, Keirse, Neilson, Crowther,
Duley, Hodnett and Hofmeyr. OUP 2000
Available online as a pdf from www.childbirthconnection.org
Researched information produced by two members of the NCT, including support on
aspects of caesarean birth and VBAC. www.caesarean.org.uk
The National Childbirth Trust is the leading charity for pregnancy, birth and parenting in
the UK. Every year it supports thousands of people through this incredible lifechanging
experience, offering relevant information, reassurance and mutual support.
www.nctpregnancyandbabycare.com
Informed choice leaflets produced by MIDIRS (Midwives Information and Resource
Service) on a range of subjects including VBAC. www.infochoice.org
Patient Advice and Liaison Service (PALS)
If you need any further information please speak to a member of staff. Alternatively,
please contact the PALS team on 01895 279831 or e- mail: [email protected]. PALS
staff will be able to provide you with ‘on the spot’ help and advice and will provide you
with any relevant information. Outside of office hours you can leave a telephone
message and we will get back to you, or you can contact the Duty Manager via the
switchboard on 01895 238282.
Data protection
The Hillingdon Hospital NHS Trust complies with the Data Protection Act 1998 and
undertakes to handle all personal information confidentially and securely. Further
information regarding your rights can be found on the Trust’s website at
www.thh.nhs.uk/Patients/Advice/rights/htm or from the PALS office on 01895 279831 /
973
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Please contact: 01895 279757
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The Hillingdon Hospital NHS Trust
Pield Heath Road
Uxbridge
Middlesex UB8 3NN
www.thh.nhs.uk
Tel: 01895 238282
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December 09
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